Insurance to cover autism therapy for kids of public workers

Originally published July 16, 2012 at 9:00 pm
Updated July 17, 2012 at 5:52 am

Children with autism whose parents are insured through the state's Uniform Medical Plan can be covered for Applied Behavioral Analysis (ABA) therapy under a settlement announced Monday by the state's Health Care Authority and a Seattle law firm, who sued on behalf of parents of children with autism and autism spectrum disorders.

It includes providing Applied Behavioral Analysis (ABA) therapy in a natural setting, such as a child’s home or community, when recommended by an autism expert to address behaviors affecting development, communication or adjustment.

“This is a watershed moment for Washington families with autism,” said Arzu Forough, CEO of Washington Autism Alliance & Advocacy and a parent of two of the named plaintiffs. “With HCA’s leadership, we are entering a new era of full coverage for persons with autism.”

Insurers often have placed limits or exclusions on ABA therapy, which is individualized, intensive and, because it often goes for long periods of time, can be very costly.

Doug Porter, director of the Health Care Authority (HCA), said families are often faced with “desperate choices, like leaving the workforce to stay home and care for a child, forgoing needed services because they can’t afford to pay, or moving out of state to find the resources they need.”

Forough and Porter said they believed the settlement, which relied on the state’s Mental Health Parity Act passed in 2005, would help families get what they need.

Whether the HCA will pay class members’ out-of-pocket expenses for past therapy will be decided in a later phase of the litigation.

The action is one of six class-action lawsuits brought by the law firm Sirianni Youtz Spoonemore against insurers’ limits or exclusions of neurodevelopmental and behavioral therapies.

A similar settlement with Group Health Cooperative, covering about 800 families, was announced last week.